Acupuncture and Electricity for Chronic Constipation: There are Buts

Anyone who has ever suffered from chronic constipation knows how miserable the condition can make you feel — headachy, bloated, and all-around unhappy; thus, the popularity of a variety of laxatives. According to proponents of "complementary" or "alternative" medicine, acupuncture can be helpful in this situation but a new report in the Annals of Internal Medicine says there are few reliable data supporting its efficacy. So Dr. Zhishun Liu from the China Academy of Chinese Medical Sciences in  Beijing and colleagues ran a multi-center trial to investigate that possibility.

Acupuncture is a standard treatment of Traditional Chinese Medicine (TCM), thought to have originated in China around 100 BC. It involves inserting thin needles at key spots along supposed energy pathways or meridians, and may be combined with other forms of treatment  by  TCM practitioners. One of those additional treatments in modern times is the use of electricity — which is the mode selected by Dr. Liu and colleagues.

These researchers' trial involved nearly 1100 individuals (between 18 and 75 years old) with chronic constipation from 15 different sites in China. Approximately half were randomly assigned to receive electricity plus acupuncture at traditional sites (group EA) and the rest received acupuncture at non-traditional sites without electricity (group SA). The EA group's treatment involved traditional acupuncture sites supposedly aligned with bowel function. Practitioners skilled in acupuncture treatment administered to both the EA and SA participants.

Participants were evaluated for baseline status, and treatments or sham treatments began 2 weeks later. Each group underwent 28-30 minute acupuncture sessions  over an 8-week period. The EA group had alligator clips attached to the acupuncture needles, and a current of 0.1 to 1 milliamp was applied. The SA group had the acupuncture needles placed in non-traditonal sites; the clips were applied but current was not used. Participants' status was followed for an additional 12 weeks after the end of the experimental period.

The primary outcome of the study was the change in the average number of complete spontaneous bowel movements (CSBMs)  observed in the 8 treatment weeks compared to that seen in the baseline 2 weeks. On this measure, the number of CSBMs increased by 76 percent in group EA, but actually decreased in the SA group by 13 percent — a difference that was highly significant. In the post-treatment period (weeks 9-20) the differences were even greater, and again statistically significant.

The authors concluded: "This multicenter trial with 1075 participants showed that EA alleviated symptoms and quality of life in patients with CSFC during the 8-week treatment; these effects persisted throughout the 12-week follow-up." They predicted that EA would be a useful mode of treatment for chronic constipation, postulating that the electrical stimulation at acupuncture points improved bowel motility by stimulating the parasympathetic nervous system. Maybe, but they could have shown much more.

The  control group (SA) they employed actually included 2 types of controls. They were not stimulated with electricity nor were the needles inserted along traditional energy meridians. Thus, the investigators changed 2 variables at the same time. It's impossible to tell from this study whether it was the acupuncture needle placement that was important, or the use of electrical stimulation. Had they found such differences when electricity was used on non-traditional points, then one could conclude that it was the electric stimulation rather than the needle placement that was important. At a time when many look askance at acupuncture as an effective treatment, this would have been an important point to make (or not). Too bad these researchers missed that goal.